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Lawmakers: Do no harm

GEORGIA LAWMAKERS should go slow on a proposal to change a rule that determines whether certain medical procedures can be performed in a physician's office.

On Tuesday, a commission that has been studying Georgia's "certificate of need" program for major medical facilities said the process needs reform, but added that loosening the restrictions on surgery centers opened by doctors may not be a viable option.

That's because no medical provider - hospitals, clinics, physicians - wants to take patients who don't have insurance or the means to pay their bill.

Physician-owned surgical centers may be less costly to operate than hospitals, which means some savings could be passed along to consumers. But if a hospital loses paying patients to a center that's around the corner, that means less revenue to cover the cost of treating patients who can't pay, but that hospitals must treat.

The survival of a hospital with large numbers of indigents could be threatened - and indirectly, so could the wallets of taxpayers who may have to cough up more money to pay for indigent care or Medicaid.

This is a complicated issue. It's also an expensive one.

Fortunately, the commission that has looked at Georgia's certificate of need program for the past 18 months recognizes this. That may explain why the panel is still working on a final draft of its report, which is supposed to be in the hands of state lawmakers when they report for duty next month for the legislative session.

Some critics have called for abolishing the certificate of need altogether. "I do believe that if you put more competition in the market, you will see a reduction in the cost of the procedure that's being done," said State Rep. Austin Scott, R-Tifton, who served on the panel.

There's some logic behind such reasoning. All HMOs - including the ones that cover Georgia's Medicaid population - force providers to compete for large pools of paying patients. When there are more places to shop around, insurers have more opportunities to bargain for lower prices.

But the flaw is that the uninsured don't shop around. Many show up in hospital emergency rooms when they need medical treatment - the most expensive place to get primary care - because they know hospitals generally won't turn them away. And if these non-paying patients are admitted, that creates more bills that hospitals must swallow.

Some hospitals are compensated for indigent care. Some aren't. But all hospitals try to absorb this red ink by passing along the costs to paying patients, especially those who underog fairly routine procedures that physicians perform in hospitals on an outpatient basis.

These hospital charges can be a facility's bread-and-butter - and taking paying-patients away makes it tougher to eat the indigent costs.

State Sen. Don Balfour, R-Snellville, a Waffle House executive, seems to understand that this a simple matter of expanding the free market. Medicine doesn't work like fast-food franchises. "When a person walks into a Waffle House, if they don't have the money, they don't get food," he said.

The situation might be different if the physician-owned surgical centers agreed to share the indigent care burden with hospitals. But so far, that doesn't seem to be the case.

That doesn't excuse hospitals - or any medical provider - for not tightening their belts and doing more to keep costs in line. The high cost of medical care and rising health insurance premiums are the causes of what's really ailing the public and private sectors.

But state lawmakers who may drop an bill into the hopper that changes Georgia's certificate of need law should recall the words commonly (and incorrectly) ascribed to the ancient physician Hippocrates: First, do no harm.